Longitudinal Association of Frailty Levels with Knee Osteoarthritis in middle-aged and elderly Chinese: A longitudinal cohort study
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Introduction Frailty and Knee osteoarthritis (KOA) are highly prevalent in middle-aged and elderly populations. However, evidence on the longitudinal association of frailty with KOA is limited. The aim of our study was to explore the cross-sectional and longitudinal effects of frailty levels on KOA in combination with phenotypic frailty and frailty index (FI). Methods The data used in this study were obtained from the China Health and Retirement Longitudinal Study (CHARLS) surveys conducted in 2011 and 2018. Patients were divided into 3 groups according to total FI concentration for logistic analysis: high (≥3rd quartile), medium (≤3rd quartile and ≥1st quartile), and low (≤1st quartile). Multivariate logistic regression model was used to explore the association of frailty status and FI with KOA. Area under curve (AUC) of the receiver operating characteristic curve (ROC) to estimate the predictive values of phenotypic frailty and FI for KOA. Restricted cubic spline (RCS) regression analysis was used to explore the dose-response relationship between FI with KOA. In addition, depressive symptom was used as a mediating variable to examine whether it mediates the association between frailty and KOA. Results After 7 years of follow-up, 11,742 participants were chosen for the longitudinal association analysis of frailty with KOA. After full adjustment, the HR (95% CI) of KOA associated with the phenotypic frailty was 2.53 (2.17-2.95; P for trend < .001) and the highest (vs lowest) quartile was 4.88 (3.86-6.16; P for trend < .001) for FI. A J-shaped dose-response relationship between the frailty index and KOA. Phenotypic frailty and frailty index significantly improved the risk discrimination of KOA (p<0.05). Social isolation symptoms played a mediating role in the association between frailty and KOA (p<0.05). Conclusions Frailty had adverse effects on KOA, with social isolation symptoms acting as the mediator.
